Israeli innovation unmasks childhood breathing problems

The Child Hood: a fuss-free way of administering aerosol-inhaled medication to wheezing infants. If you’ve ever tried to keep an inhalation mask on a baby who was having a coughing spell – due to asthma or croup – you know that it’s a frustrating, and often ineffective proposition.

Lung diseases and other breathing problems are the number-one killers of babies and children under five. And the most common method of drug delivery for lung diseases is via inhaled aerosols.

Conventional aerosol delivery to infants is via a face mask, which functions as the interface between the aerosol generator (nebulizer) and the infant’s mouth and nose. A perfect seal between the mask and the infant’s face is needed, as more than half of the drug can be lost if the mask is not a tight fit.

But who knows a baby that will sit still for the 15 minutes the nebulizer treatments generally take? The chances of achieving the required mask-to-face seal is greatly reduced with infants and the efficiency of drug delivery is in turn greatly diminished.

Now a nebulizer hood called Child Hood has been developed by Israeli company Baby’s Breath which offers of a more patient-friendly interface for improving aerosol delivery to infants.

It is especially useful for children suffering from asthma, or croup – a common viral infection among infants that causes the windpipe and voicebox to swell, and results in a barking cough, wheezing and difficulty breathing.

The hood consists of a dome-shaped enclosure placed over the infant’s head. A nebulizer is attached at the top, generating aerosol that is directed toward the patient’s face by a funnel. Aerosol therapy for wheezy infants using such a nebulizer hood has proven to be very efficient and preferred by parents, is much better tolerated by infants and simpler to operate. The medication can be administered even when a child is asleep.

The Child Hood is the brainchild of Dr. Israel Amirav, a pediatric pulmonologist at Sieff Hospital in Safed in the north of Israel.

He told ISRAEL21c that the invention was one of necessity, after he repeatedly experienced the frustration of mothers attempting to administer inhalation to their babies.“I would hear from mothers after their baby received treatment with conventional inhalers, and they would always say ‘my baby wouldn’t tolerate it – it was awful.’“I thought about how to solve the problem, and slowly came up with the idea of a hoodlike device. There was one that was used in the hospital and we weren’t sure if it was effective. But after tests, we found that it had potential if the right adjustments were made, so we started developing the Child Hood,” Amirav said.

In addition to Amirav, the research team, which has developed and tested the Child Hood, includes Dr. David Katoshevski from Ben-Gurion University’s department of biotechnology and environmental engineering, his master’s degree student Tal Shakked, and Dr. David Broday from the Technion.

According to Katoshevski, providing an efficient method to administer the treatments to infants is vital.

“This is the age group where there’s a lot of lung illness that must be treated,” he told ISRAEL21c. “The motivation behind the Child Hood is the fact that the mask, which people usually use for inhalation, is not convenient, not effective and not tolerated by infants and small children. They scream, move around and much of the medicine is lost. With the Child Hood, small children up to the age of one can get their medication administered during their sleep, and it’s user friendly for the parent and the doctor.”

Unstable breathing patterns is a characteristic of normal healthy infants during sleep. Since the patient’s breathing pattern has a major effect on drug delivery from nebulizers, the team tested air flow and drug distribution in the hood during three breathing phases: inspiration, expiration and apnea.

“Because I have extensively researched aerosols in general – in the atmosphere, in engines, sprays and lately in inhalation, I was asked to assess the Child Hood. What we’re doing is mathematical simulation of the flow field and the aerosol that’s being dispersed – how much of the aerosol is getting into the mouth,” explained Katoshevski.

He said that while the device has been proven to be as efficient as using a mask in terms of the amount of aerosol that’s dispersed, there’s still work to do in terms of optimizing the function.“We’ve conducted tests in vitro and in vivo and found the hood to be at least as efficient as using the mask, but the potential is much higher. We’re suggesting modifications to enable even more efficient drug delivery, so most of it will get to the nose and mouth and not the eyes,” Katoshevski said.

Baby’s Breath’s Managing Director Asaf Halamish told ISRAEL21c that the Child Hood would be available on the Israeli market before the end of 2004, with pharmaceutical giant Teva collaborating on distributing the product. He added that plans for the U.S. are not far behind.“We’re in contact with the FDA in the U.S. and have submitted all the relevant material in order to get clearance. We expect it’s a matter of two or three months,” said Halamish.

Katoshevski said that the basic concept of the Child Hood can be developed to include more advanced operations as well.“In the future, we’d like to be able to even use the particles of the aerosol again – the particles which are perhaps falling to the bed, maybe we’ll be able to lift them up by the flow field and get them back into the circulation,” he said.The researchers are also looking into the possibility of using their inhalation system for immunization, which would be useful in Third World countries without access to top class drugs.

But for the time being, even if it only manages to enable a baby to sleep through his drug treatment, the Child Hood will have made its mark – while making some mothers and fathers very happy.